| Objective:Juvenile idiopathic arthritis(JIA)is a group of arthritis of unknown etiology lasting for 6 weeks and with onset before the age of 16 years,which is a common type of children rheumatoid,JIA is divided into 7 types,enthesitis-related arthritis(ERA)is one of the common types.JIA-ERA has already become one of the important reasons of children joint deformity or eye disease.Studies have shown that children with systemic symptoms had more joint symptoms,needed more drugs,got poorer outcomes.In this paper,it is the first time to make a classification of the JIA-ERA,to discuss the differences between JIA-ERA with systemic symptom and the JIA-ERA without systemic symptom in clinical manifestation,laboratory examination,treatment,etc.Methods:Collected the pediatric patients from March 1,2013 to August 1,2016 in shanghai renji hospital,who were diagnosed JIA-ERA(younger than 16 years old).fristly It’s diagnosis accord to diagnostic criteria 2001 ACR made for JIA.Then the systemic JIA-ERA conform to two main standard or one main and two secondary standard.Main criteria:(1)the unexplained fever;(2)increased more than 2 times the high normal range,the ESR or CRP;(3)anemia.Secondary standards: weight loss,fatigue,muscle fatigue,swollen lymph nodes.The other were sended to the gounp of non-systemic JIA-ERA.Collecting the general situations,laboratory examinations,treatments and so on.And following up for 6 months.Then the similarities and differences were analyzed between the systemic JIA-ERA and non-systemic JIA-ERA.Results:1)Collected 78 JIA-ERA children cases,including 62 male(79.49%),16 female(20.51%).General average age was 11.93±2.46 in systemic JIA-ERA;The average age was 12.0±2.93 in non-systemic JIA-ERA,having no statistical difference(P >0.05);systemic JIA-ERA of HLA,B27 positive rate is higher(93.75% vs.60.87%),with statistical difference(P < 0.05);enthesitis in systemic JIA-ERA achieve higher rate(62.5% VS 39.13%),but no obvious difference;Sacroiliac joint involvement,anterior uveitis,level of family members of the positive family history in the two types has no obvious difference(P > 0.05).2)In the systemic JIA-ERA the physicians’ VAS,parents’ VAS,number of swelling joints,number of painful joints,CRP,leukocytes and platelets were higher than the non-systemic JIA-ERA,with statistical differences(P<0.05),the knee joint involvement in the systemic JIA-ERA are significantly higher than the non-systemic JIA-ERA,with statistical difference(P<0.05);Ig G,globulin level is higher in systemic JIA-ERA with statistical difference(P<0.05),vitamin D concentrations of the both type JIA-ERA are below normal,but there was no statistical difference between two types(P>0.05);mycoplasma pneumoniae infection and atopy is no difference between two types(P>0.05)Then we followed up them for 6 months,finding physicians’ VAS,parents’ VAS,number of swelling joints,number of painful joints,CRP,ESR,platelets In systemic JIA-ERA decreased obviously,hemoglobin improved markedly,however ESR,platelet in the systemic JIA-ERA are significantly higher than the non-systemic JIA-ERA for 6 months(P<0.05).3)The use of glucocorticoids in the systemic JIA-ERA is significantly higher than the non-systemic(50%vs5.56%),with statistically significant.4)There are no statistical difference,between the numbers achieving ACR30 in systemic JIA-ERA and non-systemic JIA-ERA with the firstly 3 months treatment(P>0.05).At the sixth months,the numbers achieving ACR30 in systemic JIA-ERA ware less than the non-systemic JIA-ERA(62.5%vs91.3%),the difference was statistically significant(P<0.05).At the same time,the total and average number of recurrences in the systemic JIA-ERA were significantly higher than the non-systemic JIA-ERA,the result having statistically significant(P<0.05).Conclusion:Systemic JIA-ERA may has longer courses and easier to break out repeatedly,comparing with the non-systemic JIA-ERA,systemic JIA-ERA may need the treatment of small dose glucocorticoids early. |
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